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General NPI Number Information
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NPI Number | 1982627774
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Entity Type | Individual
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Provider Name | CARLOS ENRIQUE FOSSI M,D.
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 01/29/2014
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Provider Practice Location Address
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Address Line | 5030 KINGSWOOD DR
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City | LAKELAND
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State | FL
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Zip | 33813-3026
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Country | US
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Telephone | 863-274-0853
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Fax | 863-582-9436
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Provider Business Mailing Address
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Address Line | 5030 KINGSWOOD DR
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City | LAKELAND
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State | FL
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Zip | 33813-3026
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Country | US
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Telephone | 863-274-0853
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Fax | 863-582-9436
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | ME51410
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | ME51410
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License Number State | FL
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